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104-10175-10179 | 2025 RELEASE UNDER THE PRESIDENT JOHN F. KENNEDY ASSASSINATION RECORDS ACT OF 1992 |

GACSF CATON

SECRET PROCESSING

FUSED

Chief, Wh Division Eng recesng REQUIRED :
pe | mea
WAI ATTERS LEASE
XX {thn 208 INOLLINS
sanaenet of Station, >fexico Ci!

a EUFF/l

ACTION REQUIRED - REFERENCES

REFERENCE: A. HMMW-I1321, 13 Fed 1963
B. HMMA~20931, 22 Mar 1963

1, Transmitted under separate cover truename attachments are the
following forms to complete Headquarters' records on subject:

a. Personal History Statement :
; b. Personai nistory S.ctc...cut Uiggontiz 1) ' ,
: c. Report of Medical History sO

2. Subject was originally recruited as a cutout for the LIHUFE/2

organization. However, his actual duties for KUBARK entail far more than

: coatact and communication with LIHUFF/2. He is an outside agent, ‘in

: ‘addition to acting as the contact between the Mexico Station and the LIEUFF/2

‘ ‘Institute, LIHUFF/1 is responsible for organizing and directing the KUWOLF

: student greups in the LIMUFF/2 project; printing and distributing of 1- <opa ganda;
planning and initiating student harrassn.ent activities. Since LIHUFE, i's
duties are those of an outside agent, nis salary was established to reimburse
him for the amount of time it is necessary for him to spend on LIHUFF
activities. In this regard, it is felt yzat the sum of $500. monthly is not an
excessive amount, Hleadquarters is sequested te process a contract for
subject in this amount. oc - f

3. Subject's social security number i0)255- =58-50a4)

Enclosures:
as stated above (UNDER SEPARATF, COVER)

taper 7h

tare CeSPAtoeD

29 Apr, 63 30 Apr 63
OFSPATCH SYMBOL AND NLAEIER !
: HMMA-21e6 { .

CScopy . a : ‘ASAE SR
» 201 0949953 a

DATE TYFLD

’ Distribution:
! = WH, w/encle

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SECRET

SOCtAL SECURITY NO,
IF SOCIAL SECURITY WO. 1S HOT AVAILABLE. SAVE FORM NO. S55
3'255-58=5884 3 “APPLICATION FOR SOCIAL SECURITY ACCS-NTS," COMPLETED AS

PROVIDED 1% DETAILED PROCEDURES.

[e\<4
21. AOCRESS OF RECZRO (In U.S.) 22. aOD8TSS (foreign
SIGNED ORIG. AND COPY + TO FINANCE: COPY + TO CFNTPAL COVER: COPY - TO SILE

PISTRTE TION:
ean

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. DO NOT USE THIS SPACE « THIS CATE (Fell'in)
pee | PERSONAL HISTORY STATEMENT ~

INSTRUCTIONS

1. Answer ail questions completely or check appropriate box. If question is aot applicable, write “NA". Write “Un-
known® only if you do not know the answer and it cannot be obtained from personal records. Use blank space at
end of form for extra details on any questioa for which you have insufficient space.

2. Type, print or write carefully; illegible or sacomplete forms will not receive consideration, _ 4

3. Consider your answers carefully. Your signature at the ead of this form will certify to their correctness. Careful
completica of all applicable questions w:) permit review of your qualifi : tions to the best advantage.

SECTION 1 _ GENERAL PERSONAL AND PHYSICAL DATA
1. FULL NAME ‘Loer-Fitst-Auddie)SOSOSCSC~SOSSSSSSSOSCSOCOC AE 3. SEX -
j t
Yi herich Alfonso Rudolph io) ! 47 iX lvece | [rewaue
a $. WEIGHT 6. COLOR UF EYES 1?. COLOR OF HAIR 56. TYPE COMPLEXION |%. TYPE BUILo
6' 3" 185 Brown iBrow: Light Med, :
10 SCARS ‘Type and Locatien) :
None ho
1h. OTHER GISTINGUSHING PHYSICAL PEATURES \
Non
14. CURRENT ADDRESS (No., Street. City, Zong, State and Country) {13. CERMANENT ATORESS CVo., Street, City. Zone, State end
Toluca Highway - Kim 19-1/ Lo | ‘ountry) AND PHONE NO.
1 Magueyito, Cuajiinalpa Same »s (12)- :
Mexico DE, Mexico Phone S0-77- oF
14, CURRENT PHONE NO. (1S. OF FICE PHONE NO. & EXT. 16. LEGAL RESICENCE (State, Terrajory of Camtry)
20-77-4371 ©8 5-96-53, OF i Mexico
17. NICKNAMES jre. OTHER NAMES YOU HAVE USED
Pancho - A! Og { None

—_ i
19. INDICATE CIRCUMSTANCES ‘including Length of Tone) UNDER WHICH YOU HAVE EVES USED THESE NAMES. . 4
{Pancha - through college -Wilice & Tucson Ariz, Aik Used to date. :
. IF LE T CHANGE. GIVE PARTICULARS (#here end dy Whet Authority) . ‘
OY i

SECTION H POSITION DATA 3
1. INDICATE THE TYPE OF WORK OF POSITION FOP aniCH YOU ARE APPLYING

sete [ee mene Ak ee

2. INDICATE THE LOWEST ANNUAL ENTRANCE SALARY YOU WILL | 1k & PLOVMENT
ACCEPT (Yar will not be conertered for uny positron mth a lowee * OATE AVAILABLE FOR EXPLOWME
antranceée aztary). $s

4@ INDICATE YOUR WILLINGNESS TO TRAVEL
Joccasiowaucy lenequenter b 'SGNSTANTLY T_Jornen: i

&. INDICATE YOUR WILLINGNESS TO ACCEPT ASSIGNMENT IN THE FOLLOWING LOCATIONS (Check ‘X) each item applicabhey
ae are ciehiaiaaataaahanisennatiaananiae —_————
WASEINGTON 0.C. PAN VONERE IM U8. TERTAIN LOCATIONS ONL ¥ (Specify:

OUTSIDE TONTINENTAL UV & i
6. INDICATE WHAT RESERVATIONS YOU BOULD PLACE ON ASSIGNMENTS OUTSIDE THE WASHINGTON. 0.C. AREA.

rors
a0 444 USE PREVIOUS EDITION, whe

Be eres +

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SECTION lit CITIZENSHIP : e

1, DATE OF BATH 2 PUCALE OF BIRTH (Cry, State, Counters | 3 PRESENT CITIZENSHIP (Councry)
Oc:, 39, 1915; Chituasua, Chil, Mexico, (U.S. WA.
4, CITIZENSHIP ATQUIRE F ACQUIRED B 5 ons NATURAL- | 6. WATURALITATION CERTIFICATE HU.
= a
| jem | Juasnmace | xoormee tect: derivitive, NA ‘ NLA
7, COURT ISSUING NATURALIZATION CERTIFICATE +8, .SSUED AT (Coty, State, Countryz
NA, | NA :

9. HAVE YOU HELD PREVISUSNATIONALITY —[10. (F YES, GIVE MANE OF COUNTRY
| [res ____{x jue NLA

10, GIVE PAG TICULARS CONCERNING PREVIOUS WATIONALITY.

N.A.

rt
12. HAVE YOU TAKEN STEPS 10 CHANGE {_[ves | 1. GIVE PARTICULARS

PRESENT CITIZENSHIP oo see
nw i NO N A i
14, 1F YOU MAVE APPLIED FO® U.S. CITIZENSHIP, WHAT IS PRESENT STATUS OF TOUR APPLICATION (First Papers, Etc.}*
— NAL
18. DATE OF ARRIVAL INUS. (16. PORT OF ENTRY ~ 17. ON PASSPORT OF WHAT COUNTRY .
1916 | _El Paso, Texas Unknowa

16. LAST U.S. VISA (No,

SECTION iv EDUCATION
1. CHECK (X) HIGHEST LEVEL OF EDUCATION ATTAINED
[cess rasn wig scnooreaapuare _—=—=~—SS”SCS*d:Csd even no ve ans ow ecouteae wo oreree |

EMiGe SCrOOL GRADUATE x BACKELCS'S DEGREE
TRAGE, SUSINESS, OR COMMERCIAL SCHOOL GRADUATE | [ SRacuare STUDY LEADING TO HIGHER DCCAEE

Type Place of Inaus)

{. 19. DATE Visa ISSUEO

wae VEODS COLLEGE OE KEES

| wasvecrs neqore PnAeTORs OECOEE

2. ELEMENTARY SCHOOL

ME C* ELEMENTAPY SirsoL
Willcox Grammar School
3. GATES ATYVENODED (Fromans ia
3922-1930

1. MAME OF HIGH SCHOOL

Willcox Union Hi

3. Bite: Aa TENDED (Fromenc rod ” 4. GRADUATE

1930-1934 . txfees to

1. NAME OF HIGH SCHOOL 2. ADORESS . City, State, Country)

8. DATES ATTENDED (Faonm-ens-Taj

4. COLLEGE O8 UNIVERSITY STUDY

DEGREE
RECO

SECTION IV

CONTINUED TO PAGE

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. SECTION IV CCAITINUED FROW PAGE 2 . .
S. UF A GRADUATE SEGOLE HAS BEEN NOTED IN ITEM &
CE BUA E SEGEEE AAS BEEN NOTED) WATEM ¢ MHICH REQUIRED SUBMISSION OF A WRITTEN THESIS, (NDICATE THE TITLE

& TRADE, COMMERCIAL AND SPECIALIZED SCHOOLS
STUDY GR SPECIALIZATICN

NY

7, MILITARY TRAINING (FULL TIME DUTY IN SPECIALIZED SCHOOLS SUCH AS ORDNANCE, INTELLIGENCE, COMMUNICATIONS, ETC)
NAME AND ADDRESS OF SCHOOL i STUOY CR SPECIALIZATION ! reo Te MONTHS

Cav. School - Basic | Troop Duty lion | 3 |
Et Riley. Kansas _———-—Harse § Mechanized . 1941

Command & Gener. nh Kah G-2 - C&GS 1943 | 3

8. OTHER EDUCATIONAL TRAINING KOT INDICATED ABOVE.

War Dept. Mis-X - Intelligence
Fort Hunt, Washington, D.C, 1943 - 6 monzhs

i
4
i

SECTION V FOREIGN LANGUAGE ABILITIES . e
COMPETENCE - IM ORDER LISTED : :

0. LANGUAGE R-Reod, W-Weite, $-Speok HOW ACQUIRED | , :

(List delow each langusse in = - t :

which you possees iny degree Equiv. FLUENT t

of competence. Indicote vax | “LENT BUT ADERUATE | ADEGUATE) UNoe.” | carve |, PRO CONTACT, cApemid

Proficiency to Read. Wee of NATIVE | FONEION. Reseancn TRAVEL weoce oF LONGED | twin siuav

Speck by plocing a check (X) | FLUENCY { _ COUNTRY) | mes ! porents: | eweles

in the appecoriate boxes? wisfarwfsfeiatsfearwispriwts ‘ :

Spanish ~
2. IF YOU HAVE CHECKED “ACADEMIC STUDY * UNDER "ROW ACQUIRED”, INTICATE LENGTH ANDO INTENSIVENESS OF stuor.

4 years ‘high school

PLAIN TOUR COVPETENCE THEREIN. = _

ast DESCRIBE. “FOUR ABLITY TO DO SPECIALIZED LANGUAGE BORK INVOLVING VOCAGULARIES AND TERMINOLOGY ™~ t
{
7

TVIFIC. ENGINEERING, TELECOMMUNICATIONS, MILITARY, AND OTHER SPECIALIZED FIELSS.
Business terminology - write. - speak - read & translate,
Soclo-Economics - write - speak ~ read & translate,

Sl iF VOU HAVE NOTED A PROFICIENCY IN LANGUAGE. @OVLD TOU GE SILKimG TO USE THis BILITY IN ANY COSI TION, FOR BHICH
VOU MIGHT BE SELECTED? { ?
X ves

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@ | SECTION VI GEOGRAPHIC AREA KNOWLEDGE AND FOREIGN TRAVEL . e

£. LIST BELOW ANY FOREIGK FEGIONS OR COUNTR.ES Ib SMICM YOU HAVE TRAVELLED OR GAINES (hOMLEDGE AS A RESULT OF
RESIDENTE, STUDY C8 OLX ASSIGNMENT. (WOSCATE TYPE OF KNOKLEDGE SUCH AS TERRAIN, HARBTAS, UTILITIES, RAIL-
ROADS, INDUSTRIES, POLITICAL PARTIES, ETC. ,

~~ | H KACce e
cates or | CWLEOGE ACQUIRED OY
i

* MAME OF i TYPE OF "  @esiDENce DATZS AND 7 work
REGION OR COUNTRY | SFECIALIZED KnowLEocE ‘| SaTraveL | PLACE OF StuDr | SES | Tavenstupe | adic

: rs eeinone [ee c
Mexicn - 5c ana Economia Present Ne A. xX |x (xX 7x

ar ics ae :

{2
[Panama Business 1945-1949 NLA, [_x |
‘ {
|

China ferrin. di 1943-1945: Noa, | x

: . ntral Am Teer Condi on '1946-Present _N,A,. f

2 INDICATE TRE PURPOSE OF wisit, RESIOENCE OR TRAVEL IN EACH OF THE REGIONS OR COUNTRIES LISTED ABOVE.

: Mexico - Business - Work Assignment ” “

{> {Panama - Business - Work Assigameat

{ 2

: China - Army,

. 2. UNITED STATES PASSPCAT NUMBER ANDO EXPIRATION CATE 1€ ISSUED.
O% |_/#118058- Expired August 20, 1962

“@ | SECTION VI TYPING AND STENOGRAPHIC SKILLS e
1. TYPING (epay . 2. SHORTHAND (wpry | 2. SHORTHAND SYSTEM USED - CKECK IX) APPROPRIATE ITEM .

kx Unknown i No { [emecs | Iseecomarinc | isTENOTYPE [| !OTHEP (Specify: 2

2. INDICATE OTHER BUSINESS MACHINES BITH WHICH TOU MAVE HAD OPERATING EXPERIENCE OR TRAINING (Complometer,
Micwogaps, Card Punch, Etc.

tad
tad

None)... Tonle gare M2 ee : i

SECTION Vill : SPECIAL QUALIFICATIONS Sd ‘
1. LIST ALL HOBBIES AND SPOVTS IN WHICH YOU ARF ACT VE OD MAYE ACTIVELY OAS ISIPATED, INDICATE YOUR PROFICIGNST

M456r Achletics - Good ; on
Riding Horseback - Good : . . :
Horse shoes - Good . . . .
Gardening - Fair : :
Bridge ~ Fair : : : v

2. INDICATE ANY SPECIAL QUSLIFICATIONS RESULTING FROM EXPERIENCE or TRAINING WHICH MIGHT FIT YOU FOR A .
PARTICULAR POSITION OR TIPE OF BORK.

NAN PS Oe Oe Sane erento ete meee rem etes

we WR ee en nn

32. EXCLUDING AUTINESS EQULIPHENT OR UAC HINES SMITH YOU MAY MAVE LISTED IN ITEM 2, SECTION VI', LIST ANY SPECIAL
SEER EPS yous POSSESS RELATING TO OTHER EQUIPMENT AND MACHINES SUCH AS OPERATION OF SHORTWAVE RAMO Cindin ‘
cote ed, sedge and rececemng),OF FSET PRESS, TURRET LATHE SCIENTIFIC AND PROFESSIONAL DEVICES. ‘

oe Ee

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- eee eee ee na ea eenerasanaeesanpeaenpennaed
: SECTION VIN CONTINUED FROM PAGE €

4. ARE (OU NOW OR NAVE YOU EVER SEEN 2 LICENSED GF CERTIFIEC MEMBEF LF ANY TRADE OR PROFESSION, SUCH as PILOT,
ELECTRICIAN, RADIO CPERATOR, TEACHER, LAWYER. CPA, MEDICAL TECaN ciAN, ETC? —_— .
. iores kno

S.1F YOU HAVE ANSWERED “YES$* TO ABSYVE. INDICATE MIND OF LICENSE AND STATE ISSUING LICENSE (Provide Lacense Regisizy
Number, if known). . .

| NA.

6. FIAST LICENSE OR CERTIFICATE (Year cs feece) 7 LATEST LICENSE OR CERTIFICATE (Year of leaus) .
NA NLA
ofhe 2 bbe

6. LIST ANY SIGNIFICANT 9UBLISHED WE TESIALS OF WHICH YOU ARE THE AUTMS® (Do NOT aubmi? copies unlens requested). INDICATE
THE TITLE, PUBLICA TON DATE, AWE TYPE OF, WRITING (NoerF iction of Sceentifc erticias, Género! Interest subjects, Novela,
tories, Etc.).

NA,
9. INDICATE ANY CEVICES @HICH YOU HAVE INVENTEO AND STATE WHETHER OR NOT THEY ARE PATENTEO. ~

NLA.
10. LIST PUBLIC SPEAKING BUF PYRU IH CF! Ewinwe EVOCoTE re

Throughout Cotlege and business career,

V1. LIST ANY PROFESSIONAL, ACADEMIC C2 “ONORARY ASSOCIATIONS OR SOCIETIES IN WK!
A VEMBER. LIST ACACEMIC HONORS YOU NAVE RECEIVED.

Alpha Zeta - Hoaorary .
Bob Cats } [University of Arizoay
Scabbard & Blad2 ss) .

cH YOU ARE NOW OR WERE FORMERLY

O€

SECTION 1X EMPLOYMENT HISTORY

NOTE: (LIST LAST POSITION FIRST.) Indicate chronological history of employment for past 15 years. Account for all periods

including casual employment and ai! ceniods of ememployment. Give address and state what you did during periodsof
anemployment. List all crvilian exstoyment by a foceign Govemment, regardless of dates. Incempleting item 9, “De-
scription of Duties® cansider your etzenence carefully and provide meanmgtul, objective statements,

3. INCLUSIVE DATES (from end To - 8) Me amd ¥e.} 2 NAME OF EMFLOTING FIRM COR AGENCY

1/1/63 - Present JAmerican Chamber of Commercé

3. ADDRESS (No., Street, Csty, State, Countrs?

3. NAME OF SUPERVISOR
Executive Committee

7. SALARY OR EARNINGS /8. CLASS. GRADE! Federal Service)

Pe. DESCRIPTION OF DUTIES

Management & direction Gf Chamber) P, rdDefend free enterprise systems) {O¢
Coordinate committee work, /Promote trade develop good will. oy:
: ;

10. REASONS FOR LEAVING

N.A,

” foamed

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-RIVON XY CONTINUED FROM PAGE §
+ INCLUSIVE CATES Fs mand Te Gp 40 and ¥r2 (2 NAME CF EMPLOYING F.2i CR AGENCY

‘Sept. 1949 - Dec al 1962 j_fR.C, Cola Company? 2?
pa ORESS (40, Street, City, State, Courssy?

1 regia

% KIND OF BUS NESS . $- NAME GF SUPERVISOR

lo oG.

aOLS
ITLE OF 5 1. SALASY OR EARNINGS 18 CLASS. GRADE Fodoral Service)
ned

Gen, Mzr, Roval Crowa, S.A of “+ 12, 009 "©" year _:

Te DESCRIPTION CF SUTIES

:Direcrion of manufacturing concentrates, Marketing. Advertising.
Development of sales, Franchising, Mexico and C. America,

1 isedjbortling plants} O&

13 REASONS FOR LE AGING

4

Transfer to States - Preffered M2xico.

3. INCLUSIVE DATES (From and Jo- By slo and Yr) 2. MAME OF EMPLOYING FIRM OR AGEKTCY

‘Dec, 1946 - Sept, 1949

.2- AGORESS(No., Seree:, City, Stare, Coancrys

Panama - Keo de Pana
16D OF Business 3. NAME er SUP eAY OK

1
‘

B og & Sales oft drink Qs Board of Directo

, 8 TITLE SF so8 . i 7. SALARY CR EARNINGS ,8. CLASS. GRADE (Tf Federal Service)
a! F195" 000, Per year!

2. DESCRIPTION OF CUTIES

Direction of Company.

10. REASONS FOR LEAVING.

{Unfavorable climatic conditions,
|

1. INCLUSIVE DATES (From and To- By Mo. and Yer} j 2 NAME CF EMPLOYING FIRM OR AGEKCY
on nee re
, 3. ADGRESS (No, Sereet, Caty, State, Ceauntryz

.
i KING OF BUSINESS 3. NAUE OF SUPERVISOR
H :

| & TITLE OF 208 7. SALARY OR EARNINGS | 8- CLASS. GRADE (II Federal Seevica)
'
H

[el cescrierion oF OUTIES

|

1 1S. REASONS FOR LEAVING

t. INCLUSIVE OATES (Fron and Te - Br Ma end Yr} 2. WAVE CF EMPLOYING FIRM OR AGENCY
2

3. ADDRESS (No., Sereet, City, State, Coumtry) .
!
bd j 4. KIND OF BUSINESS S$. NAME OF SUPERVISOR '
oot HY

: :

? GAL ae OF EARNINGS (0. CLASS. GRADEII Federal Service)

s Tren { i
SECTION IX CONTIACED TO PAGE 7

| 6. TITLE OF OR

Sante


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Te ee She

9 GESCRIPTION OF DUTIES

$6 REASONS FOR LEAVING

1. INCLUSIVE OATES (From and To- Br Mo and Ye.)

& HAME OF EMPLOYING FIRU CR AGENCY

3. ADDRESS (No . Sireee City. State, Cocmrys

4. KIND OF BUSINESS i RSME OF SUPERVISOR
& TITLE OF JOD 7. SALARY OR EARNINGS "8. CLASS. CasOE (if Federal i
+ Serveca) ‘
6 s {pee 5 :
o CESCRIPTION OF DUTIES

‘ i
30. REASONS FOR LEAVING :

{ 0. INCLUSIVE DATES (Feces and To - Br ihe end Yr} 2 RAME OF EWPLOVING FIRY OR AGENCY

3 ADORESS (No. Sirees. Cay, State, Cornry)

4. KIND OF BUSINESS _ S. AME OF SUPERVISOR .
i 4

@ TITLE OF [OB 7. SALARY GR EARNINGS 8. CLASS. GRACE if Federal

Service) :

7 3 iPER
9. OESCRIPTION OF DUTIES

. ;
(0 REASONS FOR LEAVING

6. IF PRIOR SERVICE BITH THE FEDERAL GOVEANMENT (5 NOTED ABOVE, INDICATE THE
NUMESROF YEARS CRECITABLE TOPAGS U.S. CIVIL SERVICE RETIREMENT, IF KHOUN.

8. HAVE YOU EVER SEEN CISCHARGED CR ASKED TO RESIGN FRI ANY POSITION.

HAVE TOU LEFT A POSITION UNDER CIRCUMSTANCES WHICH "CU DESIRE TO EXPLAIN? [ves Kjno -
1F YOUR ANSWER fO ELTHER OR BOTH QUESTIONS IS “YES*, GIVE DETAILS

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3

SECTION X MILITARY SERVICE
1 CURREKT OparT status = NLA,

1. ARE YOU QEGISTEPED FOR THE SPAFT UNDER jves) 2: senecr ivé SERVICE Cisse | 3. SELECTIVE SERVICE WO. |
THE UNIVERSAL MILITARY TRAINING AND me
SERVICE ACT OF 1548 (Ae srendedy . uo

aol

4. 1F SOEFERRED, GiVE REASON S$ LOTAL DRAFT eoaad w2. OR SESIGNATIO“N AND ADORESS.

2 aul {TARY SERVICE RECORD

asy PSANIZATE HAL i wees £95n0P

ee

a
7 MARINE - AIR

CHECK (XD AS
wavy | corps ' Force | cuaRD wARINE 1 Guses i

SFPROPRIATE

‘OALT WERCHANT. NATICWAL AIR NATIL, FSPEIGN ORGAN. OF mil.
be 5 T'k, SEAVICE (Spesityi:

T
H ARMY

XX.

$e

{ 1 i i

HAVE SERVED

ed - .
NOW SERVING & j : .
2. BRANCH OR CORPS OF ABOVE CHECKED ORGANIZATION(S) .
avalry - MIS___ _
2. DATE SEPARATED FROM EXTENDED ACTIVE DUTY (Past service, £. TOTAL LENGTH DF EXTENDED ACTIVE OUTY IN-U.S. ARMED
CES (Pest and carrent servic
6-46 ! . years ;

5. SATE ENTERED | PAST SERVICE T CURRENT SERVICE 6 TOTAL LENGTH OF ACTIVE OUT OUTY IN FOREIGN MILITARY Cae
ACTIVE DUTY =m) i i GANIZATION

‘Jan, 1941 ' a
1 Bane, GRADE OR PAST SERVICE CURRENT SERVICE 6. SERVICE. SEMIAL O° FILE MUNBER 2 now verving, provide <r
_ pave 7 OO: : 277220 Of

s. PaiMaRry MILITA) CCUP A’ al : PAST SERVICE :CURREN AVICE
SPECIALTY (Moe or Deelgnator) AND TITLE MIS i

Mu. “ZECOMDARY MIL. OCCUPATIONAL 1 PAST SERVICE pOURRENT SERVICE

(ower Dengnatey AND) ig oe ° 7

RA oe Ne £
tt, BRIEF DESCRIPTION OF MILITARY DUTIES (Inticate whether applicable ta peet or currens service) Past.

Troop duty - troop and squadron - horse and mechanized cavalry,
Military Intelligence - War Dept, Assigned CBI (MIS-X)

12, CHESK {x) TYPE OF SEPARATION FROM ACTIVE SUTY

_———-—
| HONORABLE DISCHARGE RETIREMENT FOR SERVICE *j WOUE MA. 2SHIPS . :
} RELEASE TO INACTIVE DUTY ly | RETIREMENT FOR COMBAT D'SASILITY eTner: .

| RETIREMENT FOR AGE i | RETIREMENT FOR PHYSICAL MCUSABILITY ]

(CHECK (X) COMPONENT IN WHICH YOU SESVES
one! and At: ronal Guacd) ae. “MER (including ATS) AU

1 REGULAR | XI RESERVE (Includmg the J

3. MILITARY RESERVE, NATIONAL GUARD AND ROTC STATUS
1 o.vou Now Mave y Ives 12. Ives 3. ane yo! |
REcERROE Mavic Ives 1 ane voyaens emrgenper-® [ves 36 yeu now amewaen or! ves
4. IF YOU HAVE ANSWERED °YES*® TO ITEMS 1,2 OR 3 ABCVE, CHECK COMPCHEMT MEMBERS? BELOW
| Xikamd — parine conrs, "wATIONAL GUARG COASTGJAPD.waWY ROE INDICATE ROTC CATEGORY Muse
ibs ANE chido Ahaha cae
AiR FORCE [AIR NATIL.GUARD ARWY ROTC / iain FORCE RotTcd BER
5S. CURREMS-RANK, GRADE OR "6 DATE OF APPOINTMENT In CURDENT |7. EXPIRATICN DATE OF CURCENT RESERVE OBUIGA
sate ft Lr, CoLhlOg . FAK 1944 i
8. CHEC! URQENHESERVE CATEGORY "READY RESERVE STANDEY(Actrwes X | STANDBY Seective) [Revers |
9. FRIMARY MILITARY OCCUPATIONAL SPECIALTY (Sos or Dealg- /1D. SECONDARY MILiTASY OCCUPATIONAL SPECIALTY (ioe oF Dee-
nator} AND TITLE Mi lapatecy AND TITLE |
Far OWT)

44. GRIEF DESCRIPTION OF MILITARY RESERVE OUTIES

N.A.

12. A@E YOU CURSENTLY ASSIGNED OR ATTACHED 19. 1F YOU HAVE ANSWERED "VES" TO ITEM 12, GIVE UNIT O98 AGENCY
Te URESERVE: NAT'L. GUARD OR ROTC TRAIN: ? AND ASORESS a

1S. 1F YOu HAVE ANSWERED eet TO Tew te, owe unit OR AGENCY

AND ADORE:

16. INDICATE TOTAL MILIT ARY SERVICE, YEARS 17. SHEQE ARE YOUR SEMVICE RECORDS KEPT?
FOR LONGEVITY PURPCSES INCLUD Unk
ING ACTIVE AND INACTIVE OUTY | TTY Unxnown


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Bato

DATE AA AAA AAR Oe CU at teenies Mniblie tment An tthe Bate ne!

STE A MAREN Me ete a mR Efrem a Me mL

q
oy

@ | SECTION xi FINANCIAL STATUS

1. ARE YOu ENTIRELY OZ FENOENT Su YOLA SALARY? _.
2.4F YOUR ANS@ER I$ "NO" TO THE S20VE, STATE SOUPCES OF OTHEG IWISME

Investments,

' 3) BANKING INSTITUTIONS WITH WHICH YOU HAVE ACCOUNTS

WAME DE INSTIT TIO; ADDRESS (Cry, State, Country)

Falls Church Bank Falls Church, Virginia : ‘
‘ Banco Nacio lai Ge f * LEO = NMLEXICO DF :
4. HAVE YOU EVER SEEW IN, OR PETITIONED FOR, BANKRUPTCY. ~~ ves “M?

3. 1F YOUR ANSWER IS “VES TO THE ABOVE, GIVE PARTICULARS, INCLUD 5G couRT AND DATES)

. 6 GIVE THREE CRECIT REFERENCES IS THE UNITED STATES

WAVE 1 ADDRESS (No., Street, City, State)

Fails Chur Bank aLis. ’ ging

7. SO YOU RECEIVE AW ANNUITY FRO THE UNITED STATES on DISTRICT CF COLUMBIA GOVERNWENT UNDER ANY RETIREMENT
ACT. PENSION, OR COMPENSATION 7 OM WILITARY OR NAVAL SERVICE? wo VES yoxe

8. IF YOUR ANSWER 1S “YES TO THE ABOVE QUESTION. GIVE COMPLETE SETA

. DO YOU HAVE ANY FINANCIAL INTEREST iN, OR OFFICIAL “CONNECTIONS WITH NON-U.S. CORPORATIONS OR BUSINESSES; OR in
OR SITH U.S. CORPORATIONS OR BUSINESSES MAVING SUBSTANTIAL FOREIGN INTERESTS?

KS ves CL! wo (If anewes *YES*, turmiah details on sepesare shect.)

e SECTION Xil : MARITAL STATUS

+. PRESENT STATUS (Sigle, Married, Urcfowed, Sepereted, Olvorced, of Anmulled; SPECIFY: h r} ie d 1
2. STATE DATE, PLACE, AND REASGS FCR ALL SEPARATIONS, DIVORCES oR ANNULMENTS

NA,

WIFE, HUSRAND If you have been martied ore than once - including annulments - use a separate sheet for former wife or

. OR FIANCE: busband grvizg data required below foe all previocs marriages. If carriage conterplated, fill in prpropriate
- information for fiance.
3. MAME (First) Neddiey Olasten) (Lest) :
Rachel Esther Williams Wichtrich | 6
4. DATE OF wanahee “Sg CE OF MARRIAGE (City, State. Comrerv) {6
Dec, 23, 1938  _t m._Arizona_~ County é ‘
£. HIS 10% MER) ADDRESS BEFORE WARRIAGE &. Steet, City, . Cowmery)

(© /{3300 Hawthorne S:,, Tucson, Ariz, U.S.A

. i, A. .
= 7. Living 18 SATE OF CEAT CAUSE OF DEATH . 5 a
xx | ves ] mr) 5 | 6 ‘ :

any er

4
1G_CURRENT AOGSESS (Guee leat adirens if dvconsed) —* : 3
Toluca Highway, Kim, 19 1/2, ELM tagueyino. Cuajima D. fexico
49, "DATE oF i 92. PLACE OF BIRTH CCuy State, Coanerv: td. CITIZENSHIP
13/191 "OF i fAvoca} Texas, U.S.A, _ U.S.A. i
O SECTION Xf CONTINUED TO PAGE 10 -
=9-

8 ee

Meas, 8 ante


14-0000

i
',
n
i
i
i.
:

Ree

wath

SECTION ZI CONTINLED FROW PAGE $_

1a. 1F BORN OUTSIDE U.S. - DATE =F ENTRY “ISTPLACE OF ENTRY

6. TDOMER CITIZEN Seis) JW. Dare Eg, ciTizensnir [i WHECE ACQUIRED (City. Stove, tanm
Ctl las,
‘ ¥ N.A, | ANTES | NLA.
NA NA et

19. OCCUPATION
j unemployed gree Leet two employers)
t

Housewife . INA.
21. EMPLOYER'S OR BUSINESS ADDRESS "No . Street Cay. State, Country)

NLA. :

22. DATES OF MILITARY SERVICE (From end to - Fy Mo and Yr)
2 , stiscn GF SERVICE

M4
25. DETAILS CF OTHER GOVERNMENT SERVICE, U-S. CR FOREIGN
BN.A,

SECTION XtIt CHILDREN ANO OTHER DEPENDENTS
1, PROVIDE THE FOLLOWING INFOOMATION FOR ALL CHILOREN AND DEPENDENTS

i

24, COUNTRY WITH WHICH MILITARY SERVICE AFFILIATED

NAME 1 PELATIONSWP | CATE AD PLACE OF BIRT | GTizensmP | ADDRESS

i ce a-10' GS, t ” | avy OG
ohn Allen Wichtrich\ 6@ Son Tucson, Arizona | U.S.A Newport, R,1

a ne en
, 23. PRESENT EMPLOYER fAleo erve fzener eriployer. ot if spouse decoased or

: F — {Unie Of NN.’ Mex,
Janet Rae Wichtrich |G Danghter /3-5-1943 ( 67 | USA, ituqucgue, Ne Wa

96 Mexico D.F

} .
2% usa. | Mexico, DF

;

~ wri O39 i
Fuss extol baugher Uae he? | usa | Movco.D-E

.

32. NUMBER Or UTHER DEPENDENTS (Inching
2 NUMBER OF CHIL DOSEN cictating ere |% numero» wrwen QerenDenTs dnctetng sar
CUMARRIED UNDER 21 Ya. OF Ase | {you Fo8 « 37 50% OF TrZIR SUPPORT, OR
AND NOT SEL F-SUPPORTING. | GHILORES, &. ce 21 V@S. OF ACE WHO ARE NOT

SECTION XIV FATHER (Give same information. tor Stepfather 204 or Guerdion Sepatale sheet}
2. LIVING | TS. DATE OF SEatH 14. CAUSE OF DEATH

ives -X}vo | Feb, 19592 Pneumonia

&. DATE OF BIRTH jy PLACE OF B:RTH (City, State, Country)

1864 Germany

9. 1F BORN OUTSIDE US.- DATE OF ENTRY | 10. PLACE OF ENTRY
Unknown_ Unknowa
wa FeRen L CITIZENSUUPIST 12. rate US. CITIZENSHIP

German 9-15" 35
14, OCCUPATION 1S. PRESENT EMPLOYER ( et employer, sf Father ie deco

Owner, Sheeimetal Shop : N.A.


14-0000

ne SECTION XV MOTHER (Give same ifturcatca tor Stepmetter on separate sheets

1. FULL NAME (LaceF irat-Muddle) 2 Living 7 IORTE OF DEATH @. CAUSE CF DEATH
Z a6 [vas y [no

Esparza Fermina b._195]_ _:_Paeumonia

YRREKT AOCRESS - Giv: ST ADORESS, iF DECEASES (No., Street, Caty, Stste, Country?

vin cox, Arizona) (O__

OF BATA 7 Poace or enba tear tae, County) Ty Chieu tee
: 1874 yChihuahua} Mexico, D.F,. {U.S.A

. S$. 5F BORN OUTSIDE U.S. - DATE MTRY (O pad, 0. PLACE oF ENTAaY

1 ~°| Unknown ' Et Paso, Texa-

Th @nERE AZQUIRED (Guy, State, Country?

‘ \B. FORMER CITIZENSHIPIS) 12. DATE U.S. CITIZENSHIP

‘Coun . ACQUIRED . . .
Komeereel 4 exican i Of ____Bisbee, Arizona _
RESENT £ GYER (Give leat exployer, tt Mother 1¢ deceased of uneoptoyed)

14. OCCUPATION

= test .
16. EMPLOYER'S BUSINESS ALORESS OR MOTHER'S BUSINESS ADDRESS IF SELF EMPLOYED

|
4
i NLA.
H 17. DATES OF MILITARY SERVICE (From-end-To) 18. SRANCH OF SERVICE 19. COumTay
Hy '
NUS : A
| 2. DETAILS OF OTHER GOVERNMENT SERVICE, U.S. OR FOREIGN
f NLA.
j e SECTION Xvi BROTHERS AND SISTERS (nciueing Halt-, Step- ead Adopted Brothers and Sisters)
yer PULL MAME (LaerFirer-Middiey a RELATIONSHIP \ “Be Cat eden Soteh (Country
: Mrs.\Ma rgaret Aaderso7) OG Sister
- 4, Cur ADDRESS (Nou, Street, City, Zone, State, Country} . S. Living "6, AGE
‘L037 Olson St,, El Paso, Texas \ (6 x ives | ‘xa 5
‘ 7 FULL NAME (Laat. irat-Middie; 2. RELATIONSHIP 2. CITIZENSHIP (Country)
2 Mrs, {Charlette Edelman\OG i
.4. Fa cun ADDRESS (No., Street, 7» Zone, Siete, Camtry} : S. Living 6. AGE
- "ves & twa |
{ 2. FULL “AME (LashFirsteMatdies - 2% RELATIONSHIP 2. CITIZENSHIP (Country)
: Ars Sister U.S.
i 14. Cul T ADDRESS (No., Street, City, Zone, State, Country) 3. Living ‘6. AGE
. 28 Nozales, Santa Barbara, California) (6 Xtves | Two f 52
2. RELATIONSHIP 13. CITIZENSHIP (Comey)
1
|
i 3. Liwas
'
“E- CURRENT ADORESS mx, Street, City, Zone, State, Country)
Los Angeles Area (Address Unknown :
| iV. FULD NAME (Leet Firatebdsdaic,s 2 RELATIONSHIP 3. CETIZEN $etIP (Country)
| Wichrrich |_O6 Broch U.S,
URARENT ADORESS(Ne., Street, City, Zone, State, Country) S. Living 6. AGE
! ves Xx [40 |
{ 1. FULA NAME fLa@at-F srat- Middle 2. RELATIONSHIP 2. CITIZENS 41P (Country)
H 7 _—— -
: 4. CURRENT ADDRESS (No., Street, City. Zone, Stare, Country) Living
{ ; ao

1. PULL MAME (Laat-Feratiddies

8. LIVING

| [ves

@. CUARENT ADOAESS (No., Street, City, Zone, State, Country)

[he PULL NAME (LootFtret-Maddies

ry :
4, CURMENT ADORESS (No.. Street, City, Zone, State, Country)

. cane
j
‘
i

‘ :

+ bade

“anew a


14-0000

TAUSE OF DEATH

Stroke

Hi

6, DATE OF BATH

Unknown

$.1F @ORN OVTUITE U.S.

TS.- DATE OF ENTRY ” a NAY OF ENTRY
NA.

Th. FORMER CITIZEMSHIPIS) 12. OATE U.S. CITIZENSHIP ACBURED | 13. WERE ACQUIRED (City, Sater Country)
Lountey (ies?

\* CITIZENSHIP

3. DATE SOF DEATH

1918

4, CAUSE OF DEATH

“Flu

it)
6. DATE OF aint

nenown b
$. IF BORN OSTSISE U.S. - DATE OF ENTRY 10. PLACE OF EeTRY

NA N,A.

12. DATE US. CITIZENSHIP ACCUIREO
NUS
18. PRESENT EWPLOYEN ‘Give lest employes, if NothspmeLaw ie deceased of unemployed) .

13. WHEPE ACQUIRED (Cay, Stare, Countey)

wr

e [section xix RELATIVES BY BLOOD, MARRIAGE OR ADOPTION WHO EITHER (3) LIVE ASROAD,
ot ° (2) ARE NOT U.S. CITIZENS OR (3) WORE FOR A FOREIGN GOVERNMENT Ni, A

+ EMPLOVED BY

4, ADDRESS OA COUNTRY IN BHICH RELATIVE RESIDES

6. OATE OF LAST CONTACT

7. FREQUENCY oF CONTALT wo St ORT AST
a
@. ADDRESS OF COUNTRY IN (cn RELATIVE RESISES

1, FULL NAWE Perey | 2, RELATIONSHIP =

eee a  AODRESE On counray wm mmicm nesATE NHS | OR COUNTRY IN WHICH RELATIVE RESIDES 5. EMPLOYED BY

6. CATEZENSHIP ;Countey) eed Of CONTACT 8. DATE OF LAST CONTACT

4 Pee NAWE (LaateFiratMiddie) 2. RELATIONSHIP aan

4, ADDRESS OR eee eee in SHICH |“ Aooness on county momen nevarwerssoes | RESIDES §. EMPLOYED BY
‘. CITIZENSHIP —— + FREQUENCY OF CONTACT 8. DATE OF Last CONTACT

SFCTION XIX CONTINUED TO PAGE 13

6. CITIZENSHIP (Country) 7. FREQUENCY SOF CONTACT

leper nee

a

1. Fuce NAME frewecmamecancrimemiay |

ae eee ea sepecinpeeenn a ney ge —ot a

%
3


14-0000

Seana URE ARTY REE NEN OEE A HONE BRITS Sentnele

. cae ae . a -
—eF cette ne ee nee ame SE

SECTION XIX CONTINLED FROM PAGE 12
& SPECIAL REMARKS, IF ANY, CONCERNING RELAT.VES HOTED IN SECTION XIX ABOVE

Any relatives I might have in Mexico or Germany are unknown, _

© section xx RELATIVES BY BLOOD, MARRIAGE OR ADOPTION WHO ARE IN THE MILITARY OR CIVIL °
SERVICE OF THE UNITED STATES

1. NAME (Lest-F iret-Aiddie)

$. ADDRESS (No., Street, City, State, Country)

1, NAME (Lactef wetdMiddie)
{S. ADORESS C¥o.. Street, Coty, State, Country)

1. NAME (Leet-Firet-Middie) 3. AGE 4 CITIZENSHIP
. |

i

5. ADDRESS (No, Sareer, City, State, Country)

SECTION XX! ____REFERENCES, ACQUAINTANCES, AND NEIGHBORS _
t- o65T FIVE CHARACTER REFERLSIES. NOT RELATIVES. IN THE U-5S.. ANG RNOW YOU INTIMATELY

NAME BUSINESS ADDRESS | RESIDENCE ADDRESS
(Leet-P isat-Middle) . {No., Street, Cate and State) j (Xo Street cur end State)

SATOMI | dd ealatvadnnatanecerteemateeenenias mmuononemntie names + on!
e

1 East 30th Stdis | :

ucso p Ona .
° Univ, of Arizona |
Pistor, Willia LOG (Animal Science i

2. LIST FivE PEASOKS IN THE U.S. WHO <NCw YOU SOCIALLY - NOT SELATIVES, SUPERYISOO: OF EMPLOYERS

NAME H BUSINESS ANNRESS ' RESIDENCE ADDRESS
(Laet-F eret-Middte) i {No . Street. Caty and State) (Na Street, Cry and Stare)
1
t

Bechtold, Edward JoyG ! : ston. Tenn ved ( :
Gra _ mi G ‘cn SOG {Vts
ven, William\©O (1P. A. aD - Miamt, Florida es estead = = = prorida.

cott Bil,\ OG Tuanoequs aa df-Xics 2
24 Carlsbad Wa

iverside, Califo ia, :
| Silver Ridze Rdjvo

3. LIST THREE NEIGHBORS AT YOUR MOST RECENT NORMAL RESIDENCE IN THE U.S.

MAME BUSINESS ADORESS RESIDENCE ADDRESS
(Leet-F eret-Middle) (Ne., Street, Caty and State) (No . Street. City and State)

13468 Gunston R Je

j_Pawley, Ted (CS : Alexandria

£

os AN fo wren kena

SE a eg ae . _ or rs

Tavemae es

14-0000

i

cememennsreetunrerts one Aine eran ment

Care

Rid Nm sen secaie. te PUES RIA

dob Sg Wat Gal tal inte Meta saat aewediecteencionm sanauannne caiman

eck Ba A ae ene one!

eatessdbtaie lia a:

wate pg NUT Maile PMS ae wee VS tate

- ole
© | SECTION Xxtt

NOTE: List nanee and addresses of aii clubs, societies, professional societies, employee groups or organizations of any kind

Cinctude memberaluip in, o¢ support of, any organization having tradquarters of branch en a foreign country) to which you
belong or have belonged. .

es

DORESS

a
- NAME AND CHAPTER (Number, Street, Caty. State, Countes>

American Club ‘| Mexico, D.F, :

amber of Commerce|

RESIDENCES FOR THE PAST 15 YEARS

Ale ic sa 7 RADE AES-SENCE CIRST
(Number, Street, City, State, Country)

Méklco, DF., Mexico 5655 Sierra Leona { (© 1949 i

Mexico, D.F., Mexico ~Toluca Highway, Kim 19 /D 69 Po

rhe §

ee BAT wing pris Biche tater

| |

Sp,

14-0000)

SECTION XXIV

1. DO YOU ADVOCATE OR HAVE Vu EVEH ADVOCATES OF ARE YOu Son OR HAVE YO. EVER BEEN A MEUEER OF;
OR HAVE YO. EVER SUPPCATES OF BEEN ASSOCIATED W TH ANS = SAITICAL PRETY INDIVIDUAL OR O8GAN-
IZATION anit ADVOCATES CS TEACHES Ire Cute inkOw OF SOVERNMENT GF TE UNITED STATES BY

ENTE OF OTKER SNSTITUTIONA. MEANS GA 3 97 FORCE OF vw SLENCE TO CENT PERSONS

TREIR AGRI UNOER THE COSsTiTUTION OF Trl UNITED STATES

2. IF YOU HAVE ANSWERED “YES* TO THE ABOVE CUESTION EXPLAIN

as T&F 80. TO WHAT EXTENTT
3. 00 YOU USE OR HAVE You - Rice 1" Niog ves
EVER USED INTOXICANTS® NO Moderate
6 IF SO. TO WHAT EXTENT?

$. DO YOU USE OR HAVE YoU ves
EVER USED NARCOTICS? Xixo

1. HAVE YOU EVER BEEN A WEWSER OF, OR SUPPORTED. OR HAD ANY CONNECTIONS atta A FOREIGN INTELLIGENCE ORGAN-
IZATION OA ITS SCTIVITIES® .
(Eves {no IF BNSWER IS “YES®, GIVE COMPLETE BETAILS. ‘

'

i

6. LIST BELOW THE NAMES OF GOVERNMENT DEPARTMENTS, AGENCIES OR OFFICES TO WHICH YOU H PP
PLOYMENT SINCE 1940 E ENTS, AGENCIES ces c U HAVE APPLIED FOR Eb

None,

NOUCTED An INVESTIGATION OF YOU, INDICATE THE NAME OF THE

NOTE SPECIAL! If your onswer is * TES" to the following Quastions 10, 11 or 12, provide the information tequested for each
INSTRUCTIONS | question on o tepcrate, signed shee? and attach the sheet to this form in a sealed envelope.
B OEY, AINED. ARRESTED, INDICTEO OR CON-

10, MAVE YOU. OR TO YOUR KNOWLZOGE HAS YOUR SPOUSE, EVER BEEK
WSaER FOR ANY VIOLATION OF THE LAWOTHER THAN A WINCR TR. FIC VIOLATION IM THE UNITED STATES OF

(€ $0, STATE WAME OF COURT. CITY, STATE, COUNTRY, DATE, NATURE OF OFFENSE AND DISPOSITION OF CASE
IN ACCORDANCE WITH THE SPECIAL INSTRUCTION ADOVE.

MAVE YOU EVER BEEN ARFESTED. COURT-MARTIALED OR OTHERWISE PUNISHED UNDER MILITARY Law on REG
USADae IF SO, DESCRIBE UNCIDENTIS) AND PROVIDE DATE(S! OF OCCURRENCE ON SEPARATE SHEET IN AC

ANCE WITH SPECIAL thSTRUCTIONS ABOVE.

r
5
i
H
H
H

ARE THERE ANY UNFAVORABLE INCIDENTS IN YOUR LIFE, NOT MENTIONED ABOVE, WHICH MAY BE DISCOVERED
IN SUBSEQUENT INVESTIGATION, WHETHER YCU WERE DIRECTLY :NVOLVED OR NOT, WHICH MIGHT RESUIRE EX-
PLANATION!E IF 50. DESTAISE INCIDENTS) AND PROVIDE DATEIS! OF OCCURRENCE ON SEPARATE SHEET IN AC>

COROENCE WITH SPECIAL INSTRUCTIONS ABOVE-

PERSON TO BE NOTIFIED IN CASE OF EMERGENCY

sian) oe

Street, City, Zone, Siese, Cantry)- INDICATE NAME OF FIRWOR|6. BUSINESS PHONE NO. a “igo

s. GusiWESS ADDF ADDRESS (No. St
PLOVER, IF APPLICABLE

merican Chamber of Commerce In Mexico
Lucerna #78, Mexico, D.F,

7. IN CASE CF EMERGENCY. OTHER CLOSE RELATIVES Moines, Failes) MAY ALSO BE NOTIFIED. IF SUGH NOTIFICATION
1S NOT CESIRAGLE, BECAUSE CF HEALTH CQ OTHER aE ASONS PLEASE STATS G {6

Mr or Mrs Ellen Claridge » 619-16ch Sc., N.W
Albuquerque, New Mexico - (Sister ln law)

5
F

seobocs

' aIS- '

we tee tao adage aawemaitagt

x
&

14-0000

Pat PLN SL Se! Wk a RMR Aleta peeencemenintene manamnen wanes te ie mata nen ss

adie BHD, S

~

estas eh Eibadasieis ine oS

=

“44. Y

SECTION YrvI _

YOU ARE INFORMED THAT THE COHRECTNESS OF srry STATEMENT WADE IN THIS 4FPLICATION
WILL BE INVESTIGATED.

CERTIF ica 7 iON

‘

ft hove read and uncerstend the instructions. | Certify thot the foregoing onswers ove true and correct fo the best of my
knowleoze ond belief. L agree that ony misstatement or o:seen at to material fact will const tute graunds for invedate
dismisses! or rejection of my opplication. | also understand that ony false stotement mode herem moy be punishable by
faw (U.S. Code, Title 18, tion 1007),

shee. t

2. DATE GF MGNATURES

TEGVEGNATURES SOS NATURE OF ameLicaNT y
1. Ff Phang G63 NAA Ade A abclodios ZA |e2

ae

3. SIGNED AY (City ond State) & SIGNATURE OF wITRESS : .

Wye hce & an Oe ae :

NOTE: Use cte rollowing apacefor extra details. Reference each continued item by tion Ang ten umber to which st relates.
S2gn }2ur name at the ead of the added maternal. Mf addinal spece is required us Iza pages the same size ss this
page and sign each suck pace. .

Section XI - (9) - Shares in Ron Castillo S.A, - Mexico, D.P. ; :
Shares in Telefonos de Mexico, S.A. .

Section XXI (3) Oaly neighbors - remaining in area.

’
n
S
t
4

ab mretecetat pe-anes orca 1986 0-—sreres

Be tubes tes Bt Fa ee ER be Sate

14-0000

: ' PERSONAL HISTORY STATEMENT — (Appendix D ;

fl

men an erent oe

Listed below are names of crganizations identified by the Attorney General, under his responsibility pursuant to

Executjve Order 10450, dated 27 April 1953, to st the names of each foreign or domestic organization, association,

movement, gro7p or combination of persons waich he des!g-atss as Totalitarian, Fascist, Communist, or subversive,
or as hat: 2g adopted or having shown 2 policy of advocatir ¥ or approving the commission of acts of force or vio-
lence to deny ethers their righ+s under the Constitution of the United States, or as seeking to alter the form of
government cf the United States by unconstitutional means.

Each appodecant or employee and spouse (if any) must review the following lst of organizations for certification

Purposes, end sign on the last page.

abrehany Lincei®t Brigade

Abraham Linco School, Chicago, Titncis

Action Commicas to Pree Spein Now

alabama Peopivs Educational Association (sco Communist Polliti-
eal Association)

American Assucution for Reconstroction in Yugoslavia, Loc.

American Braow of the Federation of Greek Maritime Unions

American Chritcaa Nationalist Party

American Comsctes for Kuropesn Workers’ Ballet (see Socialist
Workers Party?

Emrerter es Romotmne Sor Tys's. Sees of coreigm Born

American Comerctes fur Spanish

aAcerkan Comn-ncee for the Sestiement of Jews ta Birobidjan, Ine.

American Comu-tes for Yugosisy Retief. Inc.

American Coirmotee to Survey Laber Conditions tn Eurcpe

American Councl far s Democratic Greece, formerly known as the
Greek Americes: Council; Greek American Committee for Ma-
ttonal Unity

americcn Counc cn Soviet Relations

American Crostaa Congress

american Jewist Labor Council

American Natiozal Labor Party
Ametican Natiousi Socialist League
aivéinen Natoma, Socialist Party
Amerkan Matiomcss Party
American Patriom Inc,

Amerikan Peace Crome

Americas, Feace Mobluration
American Poles ir Peace

American Polish Leter Council
‘amerzicen Polish League

Spanish Aid Cun-—=irtee)

American-Russian Fraternal Goctlety

American Rassisz Enstitute, New York, also known as the Ameri-
ean Russian locicate for Cultural Relations with the Sorist
Caton

American Russier Institute, Philadelp=ss

American Rusniar Tastitute of San Prascisco

American Russics [ostitute of Southern California, Los Angeles

American Slav Compress

American Women for Peace

American Touth Ccegrees

American Youth tx Democracy

aAmmenisn Progreatre League of America

Associated Kinns cf america

Association of Grergia Klans

Amoctation ef Ge=nan Nationale (Reictateutache Vereinigung)

Ausiaod-Organiveamcn der NGDAP, Overseas Branch of Nast Party

Baltimore Forum -
Benjamin Davin Previom Comaiittee
Bteck Dregon Bocwey

American Rescue Sip Miaston (a project of the United American”

TOS" 444d use raxvious mprnoss -1-

Bown School for Marxist Broties, Boston, Massachusetts
Bridges Hobertson-Bchmict Defense Committee

Buigarian American People’s Leagues of the United States of
Amerva

Caitfornis Emergency Defense Committee
Cectornia Labor School, Ine. 121 Divisadero Street, San Francisco,
California
Carpetho-Russisn People’s Society
Curate eid Of Amercam Women of Crostian Descent. also
known as Central Counce] of American Croatian Women. Xs-
Tape) Council of Croatien Ween
Cexteal Japanese Association (Beikoku Chuo Nippenjin Kal)
Central Japanese Association of Southern Callfornis
Cexteal Oryanization of the German-American National Alliance
(Ceuteche-Ameriknnische Kinheitsfront)
Cervantes Fraternal foctety
Chios Weifare Appeal, Ine.
Chozta Cultural Center
Citizens Committee for Harry Bridces
Citizens Committee of the Tpr *° West Side ‘New York Cisy)
Citirens Committee to Foe Zor, Browder ~
(Citizens Emergency Defenw Qeatererce .
Citizens Protective League a
Cavill Lrverites Sponsoring Committee of Pittsbur. b
Civa Rights Congress and ics effaced organizations, inciuding:
Civil Pigt.ts Congress for Texas
Veterans Against Discrimination of Cir Rights Congress of
New York
Civ® Rigste Congress for Texas (ere Cirt! Rights Congress)
Columbians
Comite Courdinador Pro Yepublics Espanois
Comite Pro Derechos Ciriles
(Bee Puerta Hican Comite Pro Libertades Civfles)
Commictee for a Democratic Pur Eastern Policy *
Committee for Consututional and Political Freecom .
Cormitiee for Nationalist Action
Catnmittes for Peace and Brotherhood Festival in Phitacetphia
Committee for the Defense of the Pittsburgh fix
Comautites for the Negro in the Arts
Committee for the Protection of the Bill of Rigats ’
Cominitves for World Youth Friendship and Cultural Exchange
Comamittes to Abolish Discriminauion tn Afarylant
(See Congress, Against Discrirtnaticn: Maryland Congress

Against Discrinination: Provisional Ccmumittee to Abolish

Discrimination in the Stace of Maryland)
Committee to Ald the Fighting South i
Comsetttes to Defend Marie Richardson .

Committes to Defend the Righ*s and Freetom of! Pitubarehy -
Political Prisoners

Comnmmituss to Conoid the Bill of Rights
Commanweaith Colege, Mena, Artanss

Communist Party, U. 6 A, ite subdivisions, subsidiaries, end
afinates

4
A

nell dit ene

14-0000

Cormrritet Political Assocucion, ite subdivisions, subsidiarics, j Wndependent Peeples Party

and aS tates, Including:
Astama People’s Educecenal Association
Fuceice Press and Educaccal League
Oxahoms League for Puccical Education
Peceie’s Educational.ant Prees Association of Teras
Vorgata League for Peszes Zducalion
Conger Amincst Discrimtmcco
(See Committee to Aboligs Stecrimination im Meryland)
Congress cf Americar Revalycousry Writers
Congress of American Wore
Congrem cf the Unempioses
Conutecicut Committee to AX Victims of the Brith Act
Connecucut State Youth Guc“erence
Conner for Jobs, Relief end Rousing
Covam fot Pan-American Semocracy
CouncS of Greek Americans
Counc= on African Affairs
Crostisn Benevolent Prateruzy

Dal ¥:;yoa Butoku Kal Qamreary Virtue Society ef Japan oF MMe
tary Act Society of Japan)

Daly Weezer Press Club

Daniets Defense Committee

Dante Augiierl Gociety (between 1935 and 2545)

Dencis Defense Committes

Detrecz Youth Assembly

Pas: Esy Peace Committee __

Eiatoore Progressive League

Zmerpescy Conference wo Ssve Spanish Refurees (founding boty
Ge hid fees AMEFcaL spac. 410 Conti)

Yreryoecy’s Committee to Octiaw War

Parites of the Baltimore fern Act’ Victims
Paretiies of the Smith Act Tums
Pecerauon of Italian War Vrceracs in the U. & A. Inc. (Assocta-

Florida Presx and Educational League (sce Comsnunis: Political
Assoxtation)

Prederix Douglass Educational Center

Freedom: Stage, Inc.

Priends cf the New Germany (Freunde des Weien Deutechlands)

Prients of the Soviet Union ;

Garttecct Amevican Fratermat Society

George Washington Carver Echool, New York. Cay
German-American Bund (Acurrkadeutscher Volkesund}
Germas-american Republice= League

Germas-American Vocations. League (Deuteche-Amerikanteche

Hariem Trace Union Councd

Hawan Civil Liberties Comxr=tes

Hetrvahs Kal, also known as Nokubel Helekt Gtrueha Kal, Zatbel
XNfmen in. Hetyaku Gimusts Kat. and Zaibel He-cushe Kal (Jap-
onese Residing in Amerios Wilitary Conscripts Association}

Hellesx-American Brotherhood

Hisode Sal (imperial Japaoese Reservists)

Hinomaru Kal (Rising Sun Flag Society —a croup of Japancie
Wer Veterans)

Houde? Zaigo Shoke Dan (Hath American Reserve Officers Asso-
ctauica)

Holiywood Writers Mobilimarem for Defence

Hungeriaa-American CouncS for Democracy

Hungartan Brotherhood

Idabo Prnsicn Union
Indepenteat Party (Seattle, Washington)
(See tacepeadent People’s Party)

|

|

(3ee Indepextert Party)
Incustria! Workers of ths World
Internstional Labor Defense
International Workers Order, its subcivisions, subsidiaries end
amtiates .
Japanese Assuctasion of America -
Japanese Orereas Central Society (Ea‘gai Dodo Chuo Katt
Japanese Orerens Conrention, Tokyo Japas. 1940 :
Jepantet Prouctive Association (Recr=ttizg Organization)
Jefervon Schoel of Social Science. New Fork Cuy
Jewish Culture Society
Jewish People’s Commltiwe
Jewish People’s Fraternal Oréer .
dixypoku Inka: (The Committee for the Crome)
#ohnason-Fores; Group
(See Johnace tes}
dohnsonites
(See Johusce-Forest Group! ,
Jommt Anti-Pusct Refugee C * amizzee
Joint Council of Progressive Itallan-A-ericans, Inc. .
dooeph Wedemutyer School of Social Science. St. Louis, Misocrt

EXlbet Setnen Fal (Association of U. &. Cittrens of Japanne An-
eestry who tare returned to America after studying in cea)
Enighta of the White Cametiits
Xe Eu Ds
. S80 known as Kyfhacuser League .(Kyfsewer
Bund), Ky=taeuser Fellowship (Erftsecser Eameracects%t}
Kythaeuser War Eelief (Hyfhacuser Kr:eguniifewerk) .
3 :

Labor Council for Negro Rights
Labor Researcy Association, Inc.
Labor Youth Lesgue

Leegue for Com=0n Sense
League of Amectcan Writers

Lictor Society «Icalian *'ack Ghirts)

Macedonian-ametican Peopie’s League
Marto Morgentct Circle
Maritime Labce Committee to Defend Al Lana
Maryland Congress Against Diseriminarxa
{See Commitee to Abolish Dtsctimisetion in Maryland)
Massschusetts Committee for the Bol of Eights
RMewechusctt: Shouts Weenen for Peese (net connected vem the
MMnute Womex of the U.S. A. Inc) ‘
Msurice Braverman Defenss Communes .
Michigan Civa Rights Feceration
MOchigan Council fcr Peace .
SOchigan Bebo of Social Science 1

Nenka Teikor2 Gunvrudan (imperial Mitiary Friends Grp of
Southern Ceufornia War Veterans)

National Assocss:icn of Mezican Amesicuns (also known as Asocts-
eon Nacions. Mexico-Americana)

Sasional Blue S:ar Mothers of Americe (not to be confumt with
the Biue Star Mothers of America cxyantred in February 26a)

National Coremittee for Preedom of tha Pres

National Commi:tee for the Defense cf Pcivcal Prisoners

National Com= ites to Win Amnesy for Sith Act Victims

Natlonal Comouttee to Win the Prace

Nestonal Conference on American Pocicy “2 China snd the Per Baas
(& Conference called by the Comamntee for a Democratic far
Eastern Polis)

National Council of Americans of Croatian Descent

Rational Couns of American-Soviet Friescship

National Federation for Consusutionel Livertics

Rational Later Conference for Peace

National Negro Congress

National Negro Labor Council

toe,

14-0000

Netiensiust Party of Puerto Riso

Xuture Friends of America since 1983).

Negro Labor Viewory Comimities

Few Committee for Publications

Nihibea Kogyo Kaisha (The Greet Pujil Theatre)
Korth American Committee to Aid Spanish Democracy
North American Spanith Aid Commistes

North Palladelphia Porum

Northwest Japanese Associacion

Ohio Beboal cf Social Ectences

OklsLoma Committee to Defex4 Poiltical Prisacers

Oxisnhoma League for Poliural Education (see Communist Politi.
cal Aspoctstion)

Originas Gouthern Elans, incorporated

Pacific Necthwest Labor School, Sesztle, Washingtos

Palo Aito Peace Clud

Partie cel Puedio of Panama (operating.in the Cacst Zone)

Peace Information Center

Peace Morenent of Ethiopia

Peopie'’s Drama, Inc,

People’s Etucaticnal aud Press Association of Texas (see Commu-
mint Political Association)

Peopie’s Ecucational Assoctztim (tneorporated unger name Los
Angties Educational Associscien. Inc}, also known as Peopis's
Boducaw.ca: Center, rée wt é CGCTALY, Scopes Ot

Peop.e's Institute of Applied Begin

Peoples Programs (Seattie, Washington)

Peozie's Radio Pouncatior, Inc.

, People’s Rights Party

Phoaceiphia Labor Commitee ter Negro Rights

Phitadelphca School of Social Gctence and Ar:

Photo Leagze (New York City)

Pittsbargh Arts Club

Potltical Prisoners’ Welfare Cacmittes

Polonia Soctety of the INO

Progressive Germin-Americans, slag known as Progresstre Ger
it -Ameriesra of Chicaco-

Preit wlan Party of America .

Protestant War Veternos of the Caited Btates, Inc

Provisona: Committee of Ciitvens for Peace, Southwest Area

(See Committee to Abols® Discrimination in Masyiand)
Puerto Rican Comiie Pro Libertaces Citiles (CLO)
(See Cemite Pro Derechos CurLes}
Fucorriquens Unidus (Pcie Aitans Utlted)

Quad Cry Committee for Peace
Queersbeidge Tenants League

Sakura Kal (Patriotic Society, o¢ Cherry Asociatica — composed
Of veterans cf Rusco-Js;exese War)
Ssmoel Adams School, Boston, Masmachusetts

co te meen

Santa Berbera Peace Porum

Schappes Defense Commitee

Cexaeiserman-Derry Defense Conwatee .

School of Jewish Studies. New York Cry

Seaitie Labor School, Seattle, Wastoaen

Sexbian-American Fraternal Society

Serbian Vidordan Council

St-nto Tempies-«itatted to State Btixs. aboltzhed in 1645)

Brrer Shirt Legucn of Americas.

Savile Councti of Southern Califorcts

Gowak Workers Sactety

Sorvenian-American National Coured

Seciaust Workers Party, including arrericsn Committee foe Euro-
pean Workers’ Bevef

Schon Kal (Pacheriand Boctety)

Seuthem Negro Youth Congress

Butko Eha (Reserve Otcers Assoccazia. Les Angrics)

Syracuse Women for Peace

Tea Paine Schon of Social Science, Pailacelphis, Pennsyivanis
Tom Paine Scheel of Wesiches:er, Sew Yoru

‘Teace Tnlon Cocmmitiee for Feace
(See Trade Uncsontscs for Pesce)
Trace Union‘s:s for Peace
idee Trace Ursontsts for Peace)
‘Ist-State Negro Trade Taion Counc®

Ukrainian-Amerian Pratezsal Unicm

Union of American Croatians

Un‘on of Kew York Veverans

Usited American Spanish Aid Coxe

Trited Comcalttee cc Jewish Societes and Lan¢smanscham Fed-
erations, aso Known as Coatmacen Committee of Jewish
Landsmanseha‘cen and Praterma: Crqanizations

CUxited Committee cf South americans

United Defense Council of thesa CAS‘ornia

United Hartem Tenancs and Coxs—ners Orpanizstion

Unived May Day Comauittee

UCauited Negro and Aled Veterans ef Ameria

Tetersns Acsinet Dterrtminatian of Covd Rights Censress of New
York (see Civ Rights Congress} ‘

Yeverans of the Abraham Lincon Erigadce

Virginta League tor Peopte’s Ecacascn (ace Comrauntst Political
Assoc tation) ‘

Votce of Freedom Corumittee

Walt Whitmsn Schooi of Eocial S-ommet, Newark, New Jersey
Washizston Bookshop Associatioa

Washington Committees for Democmse Action

‘Washington Commitvee to Defend ste BL of Rights
Washington Commonwealth Pedesacun -

‘Washington Pecsion Unicon .

Wisconsia Conference on Social Leyatation

Workers Alliance (since April 1536)

Yiddisher Kultur Pasbend

Young Communtst League .
Yugosisr-Americag Cooperatire Homa, Inc.
Tugoalev Seamen's Ciud. Inc.

j
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i


14-0000

CERTIFICATION :

I certify that I have read the names of the above Usted organizziws . :

To the best of my knowledge and belief, I am not, nor have [ been z member of, coxtribated to, received liter-
ature from, dgned pections of or in bebzf of, or acterced meet:cz: of any orframizes:on listed above, or any
organization outside the United States espousing Communist, Pascict, Tcealitarian or Nix catses, except as noted
below.

To the best of my knowledge and belttef, none of my close reletiver are, nor have ever teen members of, con-
tributed to, received Lterature from, signed petitions of or in behalf of, cr attended meetixgs of any such organiza-
tions, except as noted below. .

INSTRUCTIONS

For the purpose of this certification, if an cpplicant or employee 4s completing this ferm, the term “eloze rela-
tive” will include spouse, children, perents, brothers, sisters, uncles, oud cunts, “Close re-atices” of the spouse, for
this purpose, will include children, parents. brothers, sisters, uncles, cr-¢ aunts.

Uf there are exceptions to this certificction, set forth below under 22marks all pert=ent information concern-
ing the neture and extent of your activizes or those of your ciose re-ct:zes in such crzcz-zations, including the
names of the organizctions, dates of me=bership, meetings attende4, =2les of positions hed, amounts end dates
of coutributions, rature of petilions signed failing within the meaning c7 the above certitection end circumstances |
thereof, tities and authors of literature receczed, ane dctes on which rece:czed.

In exceptions concerzing relatives, include only such information presently known to you or avaliable from
your own records. ‘

If necesscry, vse additional sheets and sign each skeet. Write no-we if there are no exceptions.

REMARKS: To be completed by Spouse | REMARKS: To ke completed by Applicant or Employee

—City ‘and State

Le PP IL er
Witness

Address — City and State Acdress -—- Czy and Gtate

Prine we D FO


